Designing An Effective And Competitive HUB Model

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Designing An Effective And
Competitive HUB Model
HUB programs provide support to multiple stakeholders and have a huge
impact on patient access to therapy in today’s challenging payer environment
I
n today’s market, there are escalating cost pressures and greater demands for affordable, value-based
treatment options. Additionally, there
are many obstacles to navigating and
effectively managing complex product
and patient services in an increasingly
competitive specialty market.
David Blanc, Vice President of Services at Advanced Care Scripts, an
Omnicare Specialty Care Group company, discussed these challenges in his
presentation at CBI’s Patient Assistance and Access Programs conference
on March 5-7, 2014. The collaborative
event offered strategies and solutions
in effectively managing a brand while
ensuring high quality patient services.
After David’s presentation, entitled
“Next Generation Distribution and
Support Services to Improve Patient
Access,” Pharmaceutical Executive
met with him to discuss his views.
As specialty drugs become more prevalent, specialty pharmacies and HUBs
are being tasked with improving their
support services. How are key stakeholders reacting to this industry shift
towards specialty products?
As the market shifts, key stakeholders
are forced to think differently. Many
specialty products focus on smaller
populations (as opposed to blockbusters), have a higher than average price,
may have payer restrictions, require
unique administration and/or have a
need for compliance oversight. The
cost of specialty drugs and clinical differentiation can impact payer decisions
that could lead to unfavorable formu-
lary decisions and higher patient copay
responsibility. Stakeholders have to
consider these inputs and each unique
aspect of their specialty product as they
think through the services necessary to
commercialize. These services are becoming commonplace and expected.
Manufacturers realize offering support
programs are necessary to stay competitive. HUBs today are offering multiple
custom, integrated services as opposed
to a “basic” offering.
Specialty pharmacies and HUBs
are being tasked with staying on top
of the changing payer environment
and making recommendations to their
manufacturer clients to further evolve
their programs. HUB programs in particular are educating themselves on
the expanded Medicaid eligibility and
coverage options and other aspects of
the Affordable Care Act. As more and
more specialty drugs enter the marketplace, HUB programs are refining offerings to ensure their drugs are competitive and their programs are viewed
as valuable.
How do manufacturer support programs impact patient access?
Based on how difficult it’s become to
navigate the payer environment, it’s not
surprising that more specialty manufacturers are turning to insurance experts
for help. When considering “coverage”
for a particular medication, it is important to determine whether the patient
has insurance that is commercially
funded, federally funded, state funded,
or low-income subsidized. For patients
without insurance, the question be-
comes: are they eligible for Medicaid or
one of the subsidized ACA programs?
A good HUB program can help the patient find out what coverage is available
to them.
The HUB is responsible for finding
the best coverage for the patient – this
may be through their medical insurance (AOB or Buy and Bill) or through
their pharmacy benefit. Once coverage
is identified, the HUB will also address
affordability concerns and help the
patient navigate additional assistance
that they may be eligible for. This includes co-pay assistance programs (discounted drug), patient assistance programs (free drug), or alternate funding
sources such as foundation assistance.
The HUB program also has a great
impact on patient access through the
support it provides to healthcare professionals. Offices that regularly prescribe specialty medication will often
have a dedicated team responsible for
completing insurance checks and responding to requests for prior authorizations. Many times when the process
becomes too cumbersome, physicians
switch to an alternative drug that has
easier access. A HUB program can alleviate the work in a physician’s office
and make sure the patient is getting
access to the drug that was originally
prescribed by the physician. Once a referral is received by the HUB program,
a full benefit investigation is done for
that patient’s specific coverage. If a prior authorization is needed, often times
the HUB can initiate or even complete
it on behalf of the physician with appropriate documentation on file. If a
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prior authorization is denied, the HUB
can aid by following the appeals process. They also handle many of the
time-consuming and deadline oriented
aspects of navigating the payer landscape, alleviating the extra work for
physicians.
What should a manufacturer look for in
a support program?
A good HUB service does a thorough
market assessment prior to making
any suggestions for the design of the
program. An analysis of the competitor’s offerings for co-pay assistance,
patient assistance, compliance calls,
nurse support hotlines, educational
materials, and other support helps create a customized program based on the
manufacturer’s specific goals and needs.
The patient population also needs to
be studied; demographics such as age,
gender, and insurance coverage help
determine the type of technology patients will find comfortable, as well as
the expected level of customer contact
and the types of patient assistance programs that will be the most valuable.
Product characteristics such as method
of dosing and dosing frequency are reviewed to determine if patient compliance, transportation, or education are
barriers that may need to be addressed.
Finally, the market assessment should
include a review of the prescriber environment. Most primary care physicians
are unfamiliar with filling out referral
forms, leaving it up to the patient to
fill. On the other hand, many healthcare specialists are more familiar with
a HUB referral enrollment and they are
eager to take advantage of the support
that the HUB provides.
Program design should also be
considered. A manufacturer who has
taken the time to evaluate the market
with a HUB service provider will likely
brought
to you by
be interested in customizing their plan.
The plan design should be able to answer the question: “What is going to
increase speed to therapy and generate
a higher conversion rate for a better
ROI?”
The types of measurement offered
by a HUB should be the final consideration when choosing a support
program. Many metrics can be used –
speed to therapy, patient satisfaction,
adherence rate, quality of benefit investigations, appeals success rate, and
physician satisfaction are just a few.
The important questions are: What
information is most important to the
stakeholder? And will the program
they are partnering with be able to supply and report that crucial information
back to them?
Finally, a support program should
provide data. The need to trend information and measure success is critical
throughout a product’s lifecycle. In
addition to key performance indicators, market trends can be tracked
and should provide information that
is both directional and actionable.
Trends in enrollment, missing information, prior authorizations, patient
copay amounts and persistency are just
a few metrics that can inform a manufacturer program of forward thinking
ideas for minor or major redesigns.
Recognizing changes in trends and being able to react to the market is key in
the successful commercialization of a
specialty product.
What makes an independent HUB program different from a support program
offered at a specialty pharmacy?
The first difference is a HUB program
does not actively dispense. Other factors to consider when developing a
HUB design are the size of the specialty
pharmacy network as well as the im-
portance of speed to therapy. In situations where a very small network of
specialty pharmacies (one or two) and
the product requires a quick time to dispense, there may be an opportunity to
create a “Central Service Provider” or
a HUB within the specialty pharmacy.
Products requiring a robust distribution strategy benefit more from an
independent HUB that provides consistency and coordination to all program
services. A HUB program typically has
a team dedicated to a single drug or
manufacturer and can move referrals
through the investigation, prior authorization, and fill stage, capturing data
in a single case management source.
This helps consolidate communication
with physician offices. A HUB program also has case managers aligned
by regions; the physician and patient
have a dedicated person they speak
with each time an inquiry is made.
This is reassuring to both the patients
and physicians and allows a relationship to be built based on their needs
and preferences.
In designing the appropriate HUB
model, the unique needs of each drug
therapy must be considered to successfully execute the program. Complex
issues including navigating through
reimbursement, addressing co-pay
challenges, supporting a patient to the
appropriate point of dispense and adherence and beyond, have to be viewed
holistically. In addition, HUB program
models will continue to morph as the
healthcare environment is changing,
new products are coming to market
and technology is evolving.
As vice president of services, David Blanc leads
a portfolio of operational business units providing patient access support services including
reimbursement hotlines, patient assistance
programs, copay assistance programs and
specialty pharmacy dispensing and adherence
services for a range of physician-administered
and self-administered products.

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